Aim: To analyze the association of labor and sociodemographic factors with cessation of exclusive breastfeeding (EBF) at 3 and 6 months of life.
Materials and Methods: A prospective cohort study (n = 529) was performed in a tertiary hospital with the Baby-Friendly Hospital Initiative (BFHI) award. Labor and sociodemographic factors were investigated. Single-term newborns were included. After 3 and 6 months, telephone calls were made to determine the type of lactation. Univariate analysis was performed with the chi-square test or Fisher's exact test. Multivariable logistic regression models were developed to determine risk factors associated with cessation of breastfeeding at 3 and 6 months.
Results: At 3 months, 523 participants (98.9%) were contacted, of whom 64.4% maintained EBF. Factors associated with cessation were pacifier use (odds ratio [OR] 3.49; 95% confidence interval [95% CI] 2.24–5.43), cesarean delivery (OR 4.49; 95% CI 2.96–6.83), no college degree (OR 2.01; 95% CI 1.35–3.01), and not attending breastfeeding support groups (OR 1.96; 95% CI 1.22–3.12). At 6 months, 512 participants (96.8%) were contacted, of whom 31.4% maintained EBF. Factors associated with cessation were reintegration into the workplace (OR 4.49; 95% CI 2.96–6.83), pacifier use (OR 3.49; 95% CI 2.24–5.43), and primiparity (OR 1.61; 95% CI 1.05–2.46).
Conclusions: Several risk factors are associated with the premature cessation of EBF. There is a need to define strategies to correct modifiable factors and to promote protective factors with the aim of improving the success rate of EBF to reach the recommendations of the World Health Organization.

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Organización Mundial de la Salud. Alimentación del lactante y del niño pequeño. 2016. Available at www.who.int/mediacentre/factsheets/fs342/es (accessed November 6, 2016).
Organización Mundial de la Salud. Lactancia maternal. 2016. Available at www.who.int/topics/breastfeeding/es (accessed November 6, 2016).
Pallás CR. Breastfeeding in Spain. A commitment by everyone. An Pediatr 2015;83:365–366.
Rius JM, Ortuño J, Rivas C, et al. Factores asociados al abandono precoz de la lactancia materna en una región del este de España. An Pediatr 2014;80:6–15.
Instituto Nacional de Estadística: Encuesta Nacional de Salud. 2013. Available at www.ine.es/jaxi/Datos.htm?path=/t15/p419/a2011/p03/l0/&file=03154.px (accessed November 6, 2016).
Bagci AT, Eriksen KG, Sobko T, et al. Breastfeeding practices and policies in WHO European Region Member States. Public Health Nutr 2016;19:753–764.
Dozier AM, Howard CR, Brownell EA, et al. Labor epidural anesthesia, obstetrics factors and breastfeeding cessation. Matern Child Health J 2013;17:689–698.
Jonas K, Johansson MB, Nissen E, et al. Effects of intrapartum oxytocin administration and epidural analgesia on the concentration of plasma oxytocin and prolactin, in response to suckling during the second day postpartum. Breastfeed Med 2009;4:71–82.
Zakarija-Grkovic I, Segvic O, Vuckovic Vukusic A, et al. Predictors of suboptimal breastfeeding: An opportunity for public health interventions. Eur J Public Health 2016;26:282–289.
Bonet M, Marchand L, Kaminski M, et al. Breastfeeding duration, social and occupational characteristics of mothers in the French ‘EDEN mother-child’ cohort. Matern Child Health J 2013;17:714–722.
Usandizaga JA, De la Fuente P. Tratado de Obstetricia y Ginecología. Madrid: McGraw-Hill-Interamericana, 1997.
Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: Wiley, 2004.
Royston P, Moons KG, Altman DG, et al. Prognosis and prognostic research: Developing a prognostic model. BMJ 2009;338:b604.
Altman DG, Vergouwe Y, Royston P, et al. Prognosis and prognostic research: Validating a prognostic model. BMJ 2009;338:b605.
Harrell FE Jr. Regression Modeling Strategies with Applications to Linear Models, Logistic Regression, and Survival Analysis. New York: Springer, 2001.
Oves Suárez B, Escartín L, Samper MP, et al. Inmigración y factores asociados con la lactancia materna. Estudio CALINA. An Pediatr 2014;81:32–38.
Prior E, Santhakumaran S, Gale C, et al. Breastfeeding after cesarean delivery: A systematic review and meta-analysis of world literature. Am J Clin Nutr 2012;95:1113–1135.
Brown A, Jordan S. Active management of the third stage of labor may reduce breastfeeding duration due to pain and physical complications. Breastfeed Med 2014;9:494–502.
García-Fortea P, González-Mesa E, Blasco M, et al. Oxytocin administered during labor and breast-feeding: A retrospective cohort study. J Matern Fetal Neonatal Med 2014;27:1598–1603.
Marín MA, Olza I, Malalana A, et al. Influencia de la oxitocina administrada durante el parto en el mantenimiento de la lactancia materna. Estudio preliminar. Acta Pediatr Esp 2012;70:269–271.
Fernández-Cañadas A, Marín MA, Olza I, et al. The relationship of the administration of intrapartum synthetic oxytocin and breastfeeding initiation and duration rates. Breastfeed Med 2017;12:98–102.
French CA, Cong X, Chung KS. Labor epidural analgesia and breastfeeding: A systematic review. J Hum Lact 2016;32:507–520.
Lozano MJ, Pallás CR, Hernández MT, et al. Uso del chupete y lactancia materna. An Pediatr 2011;74:271.e1–e271.e5.
Jaafar SH, Jahanfar S, Angolkarm, et al. Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding (Review). Cochrane Database Syst Rev 2012:CD007202.
Machado MC, Assis KF, Oliveira FC, et al. Determinants of the exclusive breastfeeding abandonment: Psychosocial factors. Rev Saúde Pública 2014;48:985–994.
Jessri M, Farmer AP, Maximova K, et al. Predictors of exclusive breastfeeding: Observations from the Alberta pregnancy outcomes and nutrition (APrON) study. BMC Pediatrics 2013;13:77.
Britton C, McCormick FM, Renfrew MJ, et al. Support for breastfeeding mothers (Review). Cochrane Database Syst Rev 2007:CD001141.
Bai DL, Fong DY, Tarrant M. Factors associated with breastfeeding duration and exclusivity in mothers returning to paid employment postpartum. Matern Child Health J 2015;19:990–999.
Natland ST, Andersen LF, Nilsen TI, et al. Maternal recall of breastfeeding duration twenty years after delivery. BMC Med Res Methodol 2012;12:179.

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Published In

cover image Breastfeeding Medicine
Breastfeeding Medicine
Volume 12Issue Number 7September 2017
Pages: 430 - 435
PubMed: 28787188


Published in print: September 2017
Published online: 1 September 2017
Published ahead of print: 8 August 2017


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Aurora Fernández-Cañadas Morillo
Department of Midwifery, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.
Modesto Durán Duque
Department of Midwifery, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.
Ana B. Hernández López
Department of Midwifery, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.
Cristina Muriel Miguel
Department of Midwifery, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.
Begoña Martínez Rodríguez
Neonatology and Newborn Nursery Division, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.
Ana Oscoz Prim
Neonatology and Newborn Nursery Division, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.
Pilar Pérez Riveiro
Neonatology and Newborn Nursery Division, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.
Angel Salcedo Mariña
Department of Obstetrics, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.
Ana Royuela Vicente
Clinical Biostatistics Unit, Puerta de Hierro Majadahonda University Hospital, Instituto de Investigación Puerta de Hierro (IDIPHIM), Madrid, Spain.
María L. Casillas Santana
Department of Nursing, Autónoma University, Madrid, Spain.
Miguel A. Marín Gabriel
Department of Neonatology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.
Department of Pediatrics, Autónoma University, Madrid, Spain.


Address correspondence to:Miguel A. Marín Gabriel, MD, PhDDepartment of NeonatologyPuerta de Hierro Majadahonda University HospitalC/Manuel de Falla s/n. CP 28222MajadahondaMadrid 28221Spain
E-mail: [email protected]

Disclosure Statement

No competing financial interests exist.

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